{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:44:31Z","timestamp":1790232271601,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Among older women (aged \u226550 years) with ERBB2 (formerly HER2 or HER2\/neu)\u2013positive breast cancer, research has shown racial and ethnic disparities in access to ERBB2-targeted therapies, with Black women receiving treatment at lower rates than their White counterparts.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine racial and ethnic disparities in receipt of ERBB2-targeted therapies and changes in receipt over time.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used Surveillance, Epidemiology, and End Results\u2013Medicare linked data from January 1, 2010, to December 31, 2020. Beneficiaries who were diagnosed with ERBB2-positive breast cancer between 2010 and 2019, were aged 66 years or older at diagnosis, were continuously enrolled in Medicare Parts A and B in the 12 months before and after diagnosis, and had localized or regional stage disease at diagnosis were included. Data were analyzed from February through September 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Race and ethnicity defined as non-Hispanic Black or African American, Hispanic, or non-Hispanic White.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The primary outcome was receipt of ERBB2-targeted therapies in the 12 months after diagnosis of ERBB2-positive breast cancer. Modified Poisson regression was used to evaluate the probability of receiving ERBB2-targeted therapy by race and ethnicity.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 12\u202f765 beneficiaries with ERBB2-positive breast cancer (median [IQR] age, 74 [69-80] years; 99.2% female), 8.1% were of Black, 6.9% Hispanic, and 85.0% White race and ethnicity, and 54.2% received ERBB2-targeted therapy. The overall proportion who received ERBB2-targeted therapies increased from 41.3% in 2010-2011 to 64.3% in 2018-2019. Compared with White patients, Black patients had a lower likelihood of receiving ERBB2-targeted therapies in 2010-2011 (adjusted risk ratio [ARR], 0.81; 95% confidence limit [CL], 0.68-0.97), as did Hispanic patients (ARR, 0.75; 95% CL, 0.62-0.92). Racial and ethnic disparities in receipt of ERBB2-targeted therapies narrowed over time, with no significant differences observed across racial and ethnic groups in 2018-2019 for Black patients (ARR, 0.97; 95% CL, 0.87-1.08) and Hispanic patients (ARR, 1.05; 95% CL, 0.95-1.16).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest a narrowing of racial and ethnic disparities in receipt of ERBB2-targeted therapies over time among older Medicare beneficiaries with ERBB2-positive breast cancer. Future research is needed to understand the practices that contributed to the narrowing of racial and ethnic disparities and to develop implementation strategies to effectively improve the quality and equity of breast cancer care.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8086","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T15:30:58Z","timestamp":1746113458000},"page":"e258086","source":"Crossref","is-referenced-by-count":6,"title":["Racial and Ethnic Disparities in Receipt of ERBB2-Targeted Therapy for Breast Cancer, 2010-2020"],"prefix":"10.1001","volume":"8","author":[{"given":"Sudarshan","family":"Krishnamurthy","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley A.","family":"Jazowski","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee"},{"name":"Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mya L.","family":"Roberson","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Reeder-Hayes","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmyn J.","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie B.","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utibe R.","family":"Essien","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles"},{"name":"Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California"},{"name":"Associate Editor, JAMA Network Open"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"issue":"1","key":"zoi250298r1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022.","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"zoi250298r2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3322\/caac.21320","article-title":"Breast cancer statistics, 2015: convergence of incidence rates between Black and White women.","volume":"66","author":"DeSantis","year":"2016","journal-title":"CA Cancer J Clin"},{"key":"zoi250298r3","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/978-3-030-20301-6","article-title":"Health and racial disparity in breast cancer.","volume":"1152","author":"Yedjou","year":"2019","journal-title":"Adv Exp Med Biol"},{"issue":"25","key":"zoi250298r4","doi-asserted-by":"publisher","first-page":"2349","DOI":"10.1056\/NEJMp2200244","article-title":"The emergence of the racial disparity in U.S. breast-cancer mortality.","volume":"386","author":"Jatoi","year":"2022","journal-title":"N Engl J Med"},{"issue":"11","key":"zoi250298r5","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1158\/1055-9965.EPI-15-0293","article-title":"Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status.","volume":"24","author":"Chen","year":"2015","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"9","key":"zoi250298r6","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1634\/theoncologist.2013-0243","article-title":"Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research.","volume":"18","author":"Wheeler","year":"2013","journal-title":"Oncologist"},{"issue":"5","key":"zoi250298r7","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1093\/jnci\/94.5.334","article-title":"Racial and ethnic disparities in the receipt of cancer treatment.","volume":"94","author":"Shavers","year":"2002","journal-title":"J Natl Cancer Inst"},{"issue":"4785","key":"zoi250298r9","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1126\/science.3798106","article-title":"Human breast cancer: correlation of relapse and survival with amplification of the HER-2\/neu oncogene.","volume":"235","author":"Slamon","year":"1987","journal-title":"Science"},{"issue":"16","key":"zoi250298r10","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1056\/NEJMoa052306","article-title":"Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer.","volume":"353","author":"Piccart-Gebhart","year":"2005","journal-title":"N Engl J Med"},{"issue":"14","key":"zoi250298r11","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1056\/NEJMoa0910383","article-title":"Adjuvant trastuzumab in HER2-positive breast cancer.","volume":"365","author":"Slamon","year":"2011","journal-title":"N Engl J Med"},{"issue":"17","key":"zoi250298r12","doi-asserted-by":"publisher","first-page":"2003","DOI":"10.1200\/JCO.2015.65.8716","article-title":"Disparities in use of human epidermal growth hormone receptor 2-targeted therapy for early-stage breast cancer.","volume":"34","author":"Reeder-Hayes","year":"2016","journal-title":"J Clin Oncol"},{"issue":"12","key":"zoi250298r13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.45906","article-title":"Racial and ethnic disparities in use of novel hormonal therapy agents in patients with prostate cancer.","volume":"6","author":"Ma","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"41","key":"zoi250298r14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/EDBK_323523","article-title":"Immune-based cancer treatment: addressing disparities in access and outcomes.","volume":"41","author":"Osarogiagbon","year":"2021","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"18","key":"zoi250298r15","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1001\/jama.2021.17764","article-title":"A policy prescription for reducing health disparities-achieving pharmacoequity.","volume":"326","author":"Essien","year":"2021","journal-title":"JAMA"},{"issue":"2","key":"zoi250298r16","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1370\/afm.2792","article-title":"Conceptualizing, contextualizing, and operationalizing race in quantitative health sciences research.","volume":"20","author":"Lett","year":"2022","journal-title":"Ann Fam Med"},{"issue":"10","key":"zoi250298r17","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1007\/s11606-024-08770-2","article-title":"Incorporating anti-racist principles throughout the research lifecycle: a position statement from the Society of General Internal Medicine (SGIM).","volume":"39","author":"Gonzalez","year":"2024","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi250298r18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/MLR.0000000000001216","article-title":"Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.","volume":"58","author":"Jarr\u00edn","year":"2020","journal-title":"Med Care"},{"issue":"3","key":"zoi250298r20","first-page":"27","article-title":"More accurate racial and ethnic codes for Medicare administrative data.","volume":"29","author":"Eicheldinger","year":"2008","journal-title":"Health Care Financ Rev"},{"issue":"8","key":"zoi250298r21","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.annepidem.2007.03.011","article-title":"A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients.","volume":"17","author":"Klabunde","year":"2007","journal-title":"Ann Epidemiol"},{"issue":"7","key":"zoi250298r22","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data.","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"2","key":"zoi250298r24","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s10549-024-07319-5","article-title":"Racialized economic segregation and inequities in treatment initiation and survival among patients with metastatic breast cancer.","volume":"206","author":"Pittell","year":"2024","journal-title":"Breast Cancer Res Treat"},{"issue":"5","key":"zoi250298r25","doi-asserted-by":"publisher","first-page":"1979","DOI":"10.1111\/j.1475-6773.2006.00583.x","article-title":"Implementing the Institute of Medicine definition of disparities: an application to mental health care.","volume":"41","author":"McGuire","year":"2006","journal-title":"Health Serv Res"},{"issue":"1","key":"zoi250298r29","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s10549-016-3927-4","article-title":"Treatment of early-stage human epidermal growth factor 2-positive cancers among Medicare enrollees: age and race strongly associated with non-use of trastuzumab.","volume":"159","author":"Vaz-Luis","year":"2016","journal-title":"Breast Cancer Res Treat"},{"issue":"10","key":"zoi250298r30","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1158\/1055-9965.EPI-23-0218","article-title":"Patterns of evidence-based care for the diagnosis, staging, and first-line treatment of breast cancer by race-ethnicity: a SEER-Medicare study.","volume":"32","author":"Herbach","year":"2023","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"4","key":"zoi250298r31","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1002\/cncr.27831","article-title":"Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer by race\/ethnicity and education within the National Comprehensive Cancer Network.","volume":"119","author":"Freedman","year":"2013","journal-title":"Cancer"},{"issue":"5","key":"zoi250298r32","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1200\/JCO.2008.17.9234","article-title":"Trends in racial and age disparities in definitive local therapy of early-stage breast cancer.","volume":"27","author":"Freedman","year":"2009","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi250298r33","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1038\/s41573-022-00579-0","article-title":"Targeting HER2-positive breast cancer: advances and future directions.","volume":"22","author":"Swain","year":"2023","journal-title":"Nat Rev Drug Discov"},{"issue":"7","key":"zoi250298r34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.11044","article-title":"Association of gender and race with allocation of advanced heart failure therapies.","volume":"3","author":"Breathett","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"9","key":"zoi250298r35","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1002\/cncr.31260","article-title":"Racial disparities in the rate of cardiotoxicity of HER2-targeted therapies among women with early breast cancer.","volume":"124","author":"Litvak","year":"2018","journal-title":"Cancer"},{"key":"zoi250298r36","doi-asserted-by":"publisher","first-page":"S383","DOI":"10.1016\/j.annonc.2020.08.442","article-title":"Patient preferences for HER2-targeted treatment of advanced or metastatic breast cancer in the United States.","volume":"31","author":"Mansfield","year":"2020","journal-title":"Ann Oncol"},{"key":"zoi250298r37","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1305544","article-title":"Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis.","volume":"11","author":"Wang","year":"2024","journal-title":"Front Public Health"},{"issue":"4","key":"zoi250298r38","doi-asserted-by":"publisher","first-page":"e488","DOI":"10.1016\/j.clbc.2021.11.013","article-title":"Health care resource utilization and costs for metastatic breast cancer patients newly treated with human epidermal growth factor receptor 2 (HER2)-targeted agents.","volume":"22","author":"Mahtani","year":"2022","journal-title":"Clin Breast Cancer"},{"issue":"6","key":"zoi250298r39","first-page":"361","article-title":"Transportation as a barrier to cancer treatment.","volume":"5","author":"Guidry","year":"1997","journal-title":"Cancer Pract"},{"issue":"1","key":"zoi250298r40","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1186\/s12905-022-01938-0","article-title":"Factors affecting timely breast cancer treatment among Black women in a high-risk urban community: a qualitative study.","volume":"22","author":"Rose","year":"2022","journal-title":"BMC Womens Health"},{"issue":"5","key":"zoi250298r41","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1002\/cncr.28977","article-title":"Racial\/ethnic disparities in knowledge about one\u2019s breast cancer characteristics.","volume":"121","author":"Freedman","year":"2015","journal-title":"Cancer"},{"issue":"6","key":"zoi250298r42","doi-asserted-by":"publisher","first-page":"691","DOI":"10.6004\/jnccn.2022.0030","article-title":"Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology.","volume":"20","author":"Gradishar","year":"2022","journal-title":"J Natl Compr Canc Netw"},{"issue":"9159","key":"zoi250298r43","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1016\/S0140-6736(99)02143-1","article-title":"Influence of delay on survival in patients with breast cancer: a systematic review.","volume":"353","author":"Richards","year":"1999","journal-title":"Lancet"},{"issue":"7","key":"zoi250298r44","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.1002\/cam4.2830","article-title":"Impact of delayed treatment in women diagnosed with breast cancer: a population-based study.","volume":"9","author":"Ho","year":"2020","journal-title":"Cancer Med"},{"issue":"6","key":"zoi250298r45","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1215\/03616878-10041135","article-title":"Pursuing pharmacoequity: determinants, drivers, and pathways to progress.","volume":"47","author":"Chalasani","year":"2022","journal-title":"J Health Polit Policy Law"},{"key":"zoi250298r8","volume-title":"Breast Cancer Facts & Figures 2022-2024","author":"American Cancer Society","year":"2022"},{"key":"zoi250298r23","volume-title":"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care","author":"Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care","year":"2003"},{"key":"zoi250298r26","volume-title":"TNM Classification","author":"Rosen","year":"2025"},{"key":"zoi250298r19","unstructured":"Research Triangle Institute (RTI) race code. Research Data Assistance Center. Accessed July 7, 2024. https:\/\/resdac.org\/cms-data\/variables\/research-triangle-institute-rti-race-code"},{"key":"zoi250298r27","unstructured":"Cancer staging. National Cancer Institute. March 9, 2015. Accessed January 28, 2025. https:\/\/www.cancer.gov\/about-cancer\/diagnosis-staging\/staging"},{"key":"zoi250298r28","unstructured":"Overview of the approach to early breast cancer in older women. UpToDate. Accessed July 8, 2024. https:\/\/www.uptodate.com\/contents\/overview-of-the-approach-to-early-breast-cancer-in-older-women"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833355\/krishnamurthy_2025_oi_250298_1745349644.02514.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T15:31:02Z","timestamp":1746113462000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":45,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.8086","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}